Inflammation is the foundation for cancer and degenerative/autoimmune diseases. Small changes in diet and exercise, e.g. omega-3 oils, vitamin D, low starch, and maintaining muscle mass, can dramatically alter predisposition to disease and aging, and minimize the negative impact of genetic risks. Based on my experience in biological research, I am trying to explain how the anti-inflammatory diet and lifestyle combat disease. 190 more articles at http://coolinginflammation.blogspot.com

Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:

Tuesday, August 18, 2009

I don’t think that I have an intolerance for grain, i.e. a gluten sensitivity, but it is so common and the biochemistry is so obvious, that it is only prudent to avoid wheat and related grain products. A low or gluten-free diet is also similar to the other common healthy diets, e.g. low carb and anti-inflammatory.

Gluten-free diets came to my attention recently in two ways. First, I saw Food, Inc., a documentary movie about abuses by multinational food processors. After that movie, I felt like I was a goose being readied for foie gras. Second, was a newspaper article on the expense of a gluten-free diet and the challenges of avoiding gluten.

I haven’t had to worry about wheat contaminating my diet, but I am sympathetic to the celiacs that I know who have to labor with a sloppy and exploitative food industry that uses the cheapest ingredients to compose the processed foods that are consumed in modern diets -- processed foods are complex blends of many different potential allergens from innumerable sources throughout the world.

A Celiac Diet Is Good for AllFortunately, the answer to pervasive gluten is just a modest modification of the basic anti-inflammatory diet that I recommend on this blog. Unfortunately, people who have already developed gluten intolerance, have probably had the problem for years before diagnosis and that means that their intestines have already suffered major physiological alterations and they have problems absorbing nutrients and vitamins. Celiacs also, because of their chronic inflammation and autoimmunity, tend to readily develop food allergies and other autoimmune diseases. The recommended anti-inflammatory diet will help to avoid celiac, put celiacs into remission and avoid development of subsequent allergies and autoimmune diseases.

Vitamin D Is Usually Deficient (and a source of inflammation)The basic anti-inflammatory diet starts with a return to optimal vitamin D with the use of an initial blood test, followed by high level supplements to reach a suitable level and then maintenance with D3 supplements of usually 2,000-5,000 IU per day. Depending on the D3 supplement, vitamin A will also need to be supplemented, because it interacts with vitamin D. Remember that sunshine is only effective in producing adequate vitamin D if you do not suffer from chronic inflammation. I would assume that all celiacs tend to be vitamin D deficient.

A Low Carb Diet Is Easier for CeliacsThe next component of the basic diet is low carbohydrates, that means a minimum of high glycemic foods, which means to avoid sugar and starch, do not cook vegetables more than necessary and don’t over-chew your veggies. This is good for celiacs, because it reduces the need for common grain foods that no one should eat: bread, cereal, pasta, etc. Everyone should lower their consumption of these wheat products in solidarity for celiacs and for general good health. Cereal is a very bad idea for children!

Eat Wild Fish or Tons of Fresh FlaxMost people eat too little omega-3 long chain fatty acids, since these are most abundant in fatty fish, such as wild salmon (farmed fish are fed corn and have reduced omega-3 and increased omega-6 fats.) Few vegetable sources are available, since the omega-3 fatty acids are unstable and present in leaves rather than seeds. Flax seeds have short chain omega-3 fatty acids and must be freshly ground and consumed by the cupful, because the conversion to the long chains, in which they are useful, is very inefficient. Most celiacs will need to use fish oil (or krill oil, if fish is not tolerated) supplements (4-8 EPA/DHA capsule per day taken in a meal rich in fats for bile uptake) to balance the ubiquitous inflammatory omega-6 in their diets.

Grassfed Meat/Eggs Are Your FriendsCeliacs should seek out grass/pasture fed meats, eggs and wild caught fish. Corn-fed animals have higher levels of omega-6 fats and these contribute to dietary inflammation. Celiacs can usually eat meat and fish and these are very healthy foods. Red meat was not shown to contribute to degenerative diseases, it was the high carbs eaten with the meat that produced the inflammation that contributed to heart disease. (Remember that statins only decrease cardiovascular disease because they inadvertently lower inflammation, not because they lower serum lipids, LDL.)

No, No’s: HFCS and trans fatsHigh fructose corn syrup and trans fats are inflammatory and unhealthy for anyone, and should be avoided as much as wheat gluten. Fruits should be eaten as seasoning, since their fructose is not healthy and they also contain ample sucrose.

Most People Would Be Healthier on a Celiac DietThe anti-inflammatory diet proposed here for celiacs should be uniformly healthy, since it provides optimal vitamins (D, C, B12, etc.), low starch/sugar/carbs, an optimal omega-3 to -6 fatty acid ratio, increased meat and saturated fats, and avoids HFCS and trans fats. The only major adjustment for celiacs would be avoidance of individual food allergens, more attention to vitamin supplements to compensate for poor absorption and replacement of wheat by rice, potatoes, etc. The low carbohydrate nature of the diet makes it more approachable, since typical carbs, such as bread and cereal are avoided and replaced with meat and vegetables.

I look forward to advice and suggestions from readers who have experience with gluten-free diets.

I have written about this speculation previously. It fits the observations that some people exposed to ample sun are still vitamin D deficient. I don't think anyone has tested the relationship between vitamin D production in skin and inflammation.

Art Your description of a proper anti-inflamatory diet for people with gluten intolerance (most of us with northern european ancestors) is superb. I preach this diet daily in my office to patients, but so few actually listen or act on my advice. I think that gluten intolerance can lead to deficiencies of D & B12 as well as hypothyroidism and thus is a factor in the development of coronary disease. Dr. Trumbower

I have been recovering my digestion from gluten intolerance and other severe allergies for the past three years. I have still a way to go but I am starting to see the light at the end of tunnel. I am 31 and feel the best I have my whole life.I can personally vouch for your recommendations because that is the exact diet I had to follow to get things back on track and I had to be very strict and still pretty much do. It's well worth the effor. Whole foods, grass fed meat/eggs and fatty acids are the way to go.

I've also not been diagnosed with celiac, but avoid grains as part of a low carb plan.

I have RA and my doc is amazed at how I'm doing. My "numbers" indicating RA are very high, but my inflammation markers are very low! I also only use OTC anti-inflammatory for pain (discomfort) control.

I also no longer have symptoms of "irritable bowel" and have gone off my reflux meds for the first time in over 15 years!

I’ve been upping my fish oil intake recently, and given this, I want to optimize my absorption. I’ve read that taking fish oil w/ MUFA in a meal context helps to optimize absorption (versus by itself or in a protein shake, etc.). Have also read that taking other PUFA (mainly n-6 fatty acids) with the fish oil hurts absorption as the n-6 and n-3 fatty acids 'compete' against each other.

What are your thoughts on this? You mention in a line that taking w/ fats (generically) can help optimize absorption. Can you elaborate?

Eshlow,Thanks for the great article. It is a nice introduction to celiac. Note that the author does not discuss the helminth approach that is listed in one figure. Hookworms can suppress, but not cure, several different inflammatory bowel diseases. It also fails to discuss the advantage to the plant of the polyglutamine-containing gluten. Also, what is the point of having a protein that increases gut leakiness? The whole idea of immunological tolerance is treated very lightly, but is critical. Why do all of the autoimmune diseases involve leaky gut? Maybe that is related to the fact that all the over the counter NSAID also cause leaky gut and bacteria enter through leaky gut.

Exercise seems to be a big deal for the health of joint surfaces, i.e. proper development of the surfaces requires load bearing. Have you tried Vicks Vaporub and castor oil applied to joints for pain relief?

One of the problems of RA is the continued use of OTC NSAIDs and the leaky gut that they cause. I have stopped using aspirin for that reason. The leaky gut contributes to chronic inflammation and aggravates RA. I don't know what the answer to pain is here, since pain results from inflammation, which may also cause leaky gut. It would probably be best to use the most dilute, i.e. non-pill, form of NSAID and work on gut flora health.

Kyle,If I remember correctly, it takes about 4 grams of dietary fat to trigger bile production and bile is needed for fat absorption. That means that the fish oil in a capsule will go right on through your gut, unless bile is produced and dissolves the oil so that it can move into the intestinal blood supply. I don't know the specifics of the fats that trigger bile release into the gut, so I just take the capsules with a meal containing meat or eggs.

Kathryn,I would be interested to know if castor oil or Vicks VapoRub applied to the same the same general area where needles are inserted for therapy has the same effects. I think that the heat/cold sensing system triggered by castor oil and menthol relieve pain and inflammation using the same Vagus nerves as acupuncture.

I have written several article on castor oil, Vicks, vagus nerves and acupuncture.

Cindy,I think that Vicks should be considered in with the traditional remedies like Arnica, which contains Helenalin a sesquiterpene lactone. Thus, the Arnica extracts have terpenoid- like compounds, similar to the turpentine in Vicks. They both have thymol or similar compounds. So Vicks is just a processed and recombined form of the traditional plant extracts (including menthol, eucalyptol and camphor) that were found to remedy pain and inflammation.

I eliminated gluten from my diet about six months ago to see if it would have any effect on my grass pollen allergy. For the last twenty years I have had to take anthistamine pills for several weeks in every summer. This year I took *one* (after a three-hour walk through acres of flowering grass). The symptoms on that one occasion seemed to subside rather quickly; in previous seasons, if I'd exposed myself to that much pollen, taking a pill afterwards would not have saved me from a whole night of sneezing. I also seem less sensitive to nettle stings than I used to be.

I don't miss wheat etc. at all. I've been wondering, though, if everybody becomes unable to process gluten after not eating it for months. I accidentally did consume gluten on two occasions during that period and found that it caused, shall we say, an unduly rapid transit.

Valda,My feeling is that gluten intolerance is very wide spread and may be the major source of the immune system dysfunctions that we see as allergies and autoimmune diseases.

That would mean that your hay fever may be a secondary symptom of celiac and stopping gluten exposure may be reducing all of your symptoms. Reduced exposure to gluten may, however, reduce your tolerance to gluten. I don't know why that is the case. I will keep it in the back of my mind along with why tolerance was lost in the first place.

It has been observed that celiac will develop more slowly in those at high risk, if they are not exposed to gluten for the first year of life. I don't know why tolerance is prolonged or why it breaks down.

I have been gluten free for the past 6 years and grain free for about a year. Going gluten free turned around multiple health problems. About 13 yrs ago I started having symptoms of heart disease. I went through a few stents and finally a bypass on the LAD. Inflammation was high as my hs-CRP was over 13 and my whole body hurt.

After getting off gluten and taking other steps to reduce inflammation, my CRP has slowly fallen to 2.2. When I wake up in the morning, nothing hurts.

I don't know if I have celiac disease, but I know that gluten makes me sick. I used Enterolab to confirm that I do have antibodies to gluten - this is not a test for celiac disease.

My dog is also gluten free/grain free. She developed muscle wasting, difficulty walking, choking on food and water and started urinating in her sleep. All these symptoms disappeared with a change in her diet.

Evelyn,Thanks for the resources. Your perspective is always appreciated.

Thanks also for the clarification of my position. I was not advocating the typical celiac diet, because I would consider that to be inflammatory. As you point out, the high carb version is hyperglycemic. In contrast, I start with a low carb, low starch/sugar, perspective and suggest that with that starting point it is much easier to construct a gluten-free diet.

My naive perspective is that recasting meals without the wheat/grain, gluten components produces a healthier and cheaper (compared to special gluten-free products) diet that is healthier for everyone.

There is no reason to search for bread substitutes that are low in gluten, just get rid of the bread. Gluten-free bread is like a tofu turkey for a vegetarian.

The controversial part is how many grams of carbs constitutes a healthy, anti-inflammatory low carb meal. 20 to 50 grams?

Arnoud,I agree. Most nutritionists and dietitians do not read the biomedical literature, and the lobbying power of the grain industry is much more effective at controlling government policy than is my blog. Many physicians still believe in the industry-dictated food pyramid. Of course, the biomed literature is also fraught with false conclusions, such as those presented on the web site you provided. Comparing baguettes with course grain bread is a silly justification to say that whole grains reduce heart disease. Cutting out the grain would be a further improvement over a high carb/starch diet.

The same kind of faulty research design was used to suggest that red meat is hazardous to your heart. Unfortunately in the study no one noticed that the people eating the red meat were on a high carb diet. Bogus.

Conclusions: We found no evidence that higher consumption of LCFAs and fish reduces the risk of T2DM. Instead, higher intakes may modestly increase the incidence of this disease. Given the beneficial effects of LCFA intake on many cardiovascular disease risk factors, the clinical relevance of this relation and its possible mechanisms require further investigation.

I don't worry about fish oil and I can feel the difference in my own tendonitis, if I fail to take fish oil for a few days or I increase omega-6 oils, etc.

The study that you cite is just one among hundreds in which the omega-6 oil levels are not lowered before omega-3s are increased. A meta study of 250 omega-3 research articles concerned with mental health attributed the scatter of positive and negative results to the fact that nobody bothered to check the omega-6 oil levels. Omega-3 to -6 ratio is what is important and at higher omega-6 levels and with other major sources of chronic inflammation, e.g. obesity, very large amounts of omega-3 oils may be needed to have an impact.

It makes little sense to check the histories of people who develop an inflammatory degenerative disease to see if they took omega-3 oils, because those with symptoms leading to the disease will tend to take omega-3s inadequately. Those who took the optimal amount would not have developed the disease. The experiments are just silly and are designed to support pharmaceutical use instead of cheap and effective dietary alternatives.

Thank you for another great piece. I'm a bit curious about your mention of avoiding starches and not chewing veggies too much. What is it about starches (other than those who need to watch blood sugar) that you worry about? Later, you mention adding potatoes and rice, so mostly just curious.

Anne:

If you happen to see this, do you have a resource you can share for a practical and not too expensive way to feed a dog a grain free diet? I had my dog on lamb and rice for years, but it was packaged.

Cristian....I agree with Dr a, the study is useless!! Simply taking fish oils or increasing fish intake is not enough....even tho so many think it's the perfect solution!!

Commercial vegetable oils high in omega 6 are horrible for you! They are heat treated, damaged and then treated with chemicals to take away the evidence of rancidity! Corn, canola, soy, etc should not be eaten by anyone!

Polyunsaturatates are very unstable, so care should be taken even with fish oils! Make sure they are fresh when purchased and every few weeks thereafter....bite into or cut into a capsule and taste or smell the oil....if it smells "fishy" throw them out!

Nick...try just a raw meat and bones diet. It can get expensive, but if you have a butcher nearby or can make a deal with a local food store, it is not too bad.

Nick,There are two points with respect to starch. The first is that starch is the fastest source of glucose into the blood. Amylase in saliva rapidly breaks down the glucose polymer starch into sugar fragments, oligosaccharides that are converted to glucose and transported into the cells lining the gut. The more you chew, the faster the glucose gets into your blood and contributes to your blood sugar. Blood sugar, glucose, is very reactive with amino groups on proteins and produces glycation products that bind to the AGE receptor and trigger inflammation. The higher the glucose the greater the inflammation. Insulin is also induced by a rise in blood sugar and it is a hormone associated with inflammation.

The second problem with starch is that it is usually obtained from grains and many people are intolerant of the gluten in grains. Intolerance to gluten is a major contributor to chronic inflammation and an entry into allergies and autoimmune diseases.

So, I recommend avoiding grains and using small amounts of potatoes and rice, as an alternative for flavoring or texture in meals. I also refrain from eating substantial amounts of fruits, because they have few phytochemicals and significant amounts of sucrose and fructose.

Raw meat and bones is a little too hard core for me. I enjoy a rare steak, but my wife certainly enjoys chewing the tasty meat from the bones. I concede that grilling generates some nasty compounds, but I enjoy the flavor and rely on my potent detox system to provide adequate protection. I also think that veggies provide protection for nutrients during digestion in the stomach.

Nick, just google (a verb!) BARF diet for dogs. You'll get all the technicalities. It's much harder for cats, I've never gotten my cats on BARF. I used to feed my shephard chicken neck and backs with a little grain (usually oatmeal or rice) and some veggie (of course I used all sorts of meats and fish-she loved sardines). She was gloriously healthy. DON'T cook the meat!!! Dogs are good with raw meat and bones. She never had a problem with the bones or with diarrhea. And the look on her face when I gave her a big beef bone with most of the meat still on...

You've previously written about the pro-inflammatory nature of smoking cigarettes. Why, then, is cigarette smoking correlated with the the reduced rates of many inflammatory conditions, such as ulcerative colitis and inflammatory bowel disease, and allergies. It also seems to have a protective effect against Parkinson and Alzheimer's. I'd like to hear your opinion.

Tobacco smoking exposes the lungs and, via the blood stream, the rest of the body to extraordinarily potent toxins and carcinogens, but it also provides a powerful anti-inflammatory agent, nicotine. I think that in the absence of nicotine, tobacco smoke would be amazingly dangerous. It would provide a devastating mixture of carcinogens and inflammatory agents, and would quickly kill through direct toxicity and cancer production.

Nicotine, perhaps the most addictive drug in common use, holds much of the deadly qualities of tobacco in check. It makes sense to stop smoking by prolonged use of nicotine and eliminate the nicotine addiction later when the added inflammation of withdrawal will not support the incipient cancer that has already accumulated throughout the body of a smoker.

I think that the anti-inflammatory effects that provide protection from inflammatory degenerative diseases, as you indicate, results from the nicotine.Withdrawal from the nicotine results in inflammation, which is the source of the withdrawal symptoms. Protection from the diseases can also be achieved without the addiction by using the anti-inflammatory diet.

Smoking cessation should be supported by the anti-inflammatory diet and lifestyle that is promoted on this blog.

Niacin and nicotine are unrelated chemically and are not interconverted. The flush of niacin is different from the rather large number of effects of nicotine.

Withdrawal from nicotine results from its impact on neurotransmitters and it is more addictive than cocaine. Only a tiny amount of nicotine from the tobacco survives incineration in the smoke and that is why chewing tobacco releases more nicotine into the blood.

Many of the dangerously toxic and carcinogenic compounds produced in tobacco smoke accumulate in filters. The filters are too dangerous for most trained technicians in a typical biochemistry lab to handle -- it would violate OSHA safety regulations. Special air handling would be required. Tobacco butts should be strictly regulated and disposed under biohazard regulations. They are very dangerous to children and animals.

It is shocking that the impact of tobacco smoke compounds, such as nicotine, have not been systematically studied for carcinogenicity and birth defects. It is also amazing the the benefits of smoking have been touted, but then subsequently discounted in further studies, e.g. smoking initially used to treat schizophrenia and later shown to be a risk factor. This suggests that the tobacco industry may be controlling research.

Tobacco smoke should be treated similarly to snake venom. It is a source of very powerful substances that disturb normal tissue functions through specific interactions with numerous neurological receptors. Some of the compounds might be useable as therapeutic drugs and others may suggest development of pharmaceuticals, but all must be regulated because of their acute toxicity.

Any chance you would chime in on the nutritional completeness of the diet you recommend.

On paper, a high grass fed meat /fish/chicken diet with a little added fruit and veggies seems perfect.

Any worries that calcium/mag/folate/potassium/molybd might be too low-- also, there isn't much copper in the diet without organ meats and most fruits and veggies don't supply much-- and we know that grass fed beef has a lot of zinc-- any problems there by throwing off zinc/copper balance?

I'm really trying to design my diet without supplements-- and its seems that without consuming bone broths or organ meats once in a while-- it really seems this kind of diet may have deficiencies in minerals over time-- of course, i try to remedy this by eating plant foods (fruits and veggies)-- which I'm not sure if that is a good permanent solution.

I don't mean to derail the comments, but tobacco is something I'm very interested in, and I appreciate your comments.

I did know that the majority of Schizophrenics smoked, but I didn't know that anyone had been able to establish causality. Isn't it more likely that they are self medicating in some way. After all, Tobacco couldn't produce nothing but negative effects on the user. Also, it seems that most Schizophrenics do not contract lung cancer.

I've come across the argument that statistics on tobacco and lung cancer are misleading. The definition of a former smoker, for instance, might be someone who had smoked 100 cigarettes total. Also, tobacco users are a self-selecting group. The poor smoke more than the rich, and smokers also are likely to work in toxic environments. The argument reminds me of Peter's fruit and vegetable argument over at hyperlipi: Fruit and vegetable intake is correlated with health, but fruit and vegetables are not necessarily healthy.

I read that animal studies have been unsuccessful at using tobacco smoke to produce lung cancer. I've done some digging, can't find anything that says otherwise. Anyone know if this is true?

Wouldn't flax seed oil be a better choice than ground flax seeds for ALA? Even a few tablespoons of flaxmeal contains a significant amount of lignans, which are healthy of course, but I wouldn't overdo it, seeing as how they might affect hormone levels.

JLL,There are lots of problems with taking flax to lower inflammation. The first is that the ALA needs to be lengthened and this is very inefficient. That means that large amounts of flax must be eaten.

The next problem is availability of the ALA in the seed. Grinding of the flax seed is required. If the ALA is exposed ahead of time, it is readily oxidized, as are all of the omega-3s.

So, it will be difficult to get much anti-inflammatory benefit from flax seed without eating quite large amounts and preparing it just before eating.

The lignans in flax seed are not very active as estrogens and it takes huge amounts, as the study you cite indicates, to have a measurable effect. I wouldn't worry about the lignans.

Dr. Ayers,You recommend a higher intake of omega 3.I find that the most cost effective source are tinned sardines, mackerel and pilchards in brine. The brine is important because most of the other choices are vegetable oil based. Tomatoe sauce is constituted mainly of vegetable oil. It perplexes me that the canning companies promote the omega 3 benefits whilst loading omega 6 in most of the choices available. I don't know if these canned fish are freely available in your neck of the woods.Do you recommend any low cost sources of omega 3?

Another point you may wish to consider for your excellent blog. Would it be possible to have a recent comment listing on the home page? I know that you will be aware of my posting, but other avid readers of your blog would appreciate your older posts and the comments made. I can spend hours going through your older postings. You really are an inspiration and a genuine source of information and lateral thinking.

Bill,I personally find it challenging to search for good sources of long chain fish oils, so I just use fish oil capsules. I can save money by reducing the vegetable oils in my diet, so that I don't need as much omega-3s to balance.

Thanks for the suggestion to have a recent comments widget. You wouldn't know that I took my first computer programming course in 1964 and worked as a systems programmer in college, based on my lack of sophistication with Blogger. Age makes me choose to be ignorant.

I am fascinated to learn from Dr Ayers that nicotine is a powerful anti-inflammatory agent. I started suffering from hay fever in my early thirties, about a year after I'd moved from London to the deep countryside. I'd always supposed that the sheer abundance of grass pollen out in the sticks was the cause. But it so happens that I stopped smoking soon after moving to the countryside. I wonder if that was a factor.

Hello,I've learned so much from your blog and I'd like to thank you for writing. Over the past five years, since contracting mono at the age of 19, I've suffered from poor health and illnesses. This started my journey on educating myself outside of standard medicine, which fell short for me early on in this mess. I can't "hang out" like my friends can. I get sick very easily. I recently began a gluten-free diet, and supplementing responsibly under the guidance of a health care practitioner, and though I feel somewhat better, if my diet is only slightly off, my immune system is in the tank again. I am desperate. Because of family/emotional stress, I've noticed certain symptoms worsening. I suspect thyroid issues, but my levels are normal. Doctors won't listen. I don't have much money, and the RN who guides me with supplementation doesn't accept insurance so I try not to contact him often. But I don't know what to do. I showed signs of slight anemia but I have a genetic trait of Thalassemia Beta. I have a question. You said:

"Unfortunately, people who have already developed gluten intolerance, have probably had the problem for years before diagnosis and that means that their intestines have already suffered major physiological alterations and they have problems absorbing nutrients and vitamins. [...] The recommended anti-inflammatory diet will help to avoid celiac, put celiacs into remission and avoid development of subsequent allergies and autoimmune diseases."

But what can be done about autoimmune diseases that have already developed? I guess I'm asking a broad question here, but... what can I do about this? I don't want to list all my symptoms and take up half of this page. I am just wondering... after all this damage has been sustained, leaky gut and cocktails of autoimmune disorders... what can be done? Can it be fixed? I feel so discouraged. I am young and yet I have to live like I am much older... I can't drink, I can't stay up late, I feel depressed and anxious. I want my life back. I have tried everything. I am miserable.

Thanks to everyone for the references on how to feed a dog properly. Art, you gave yourself away when you said you wife likes to knaw on the bone!

Art, you made a reference to how one actually becomes more sensitive to gluten after avoiding it for some time. I certainly found that out this week, as I inadvertantly ate bacon that was treated with malted barley and sugar. Besides a few days of stomach distress there was quite an increase in joint stiffness and pain. I have been grain free about six months and find I am much more sensitive to the effects of sugar and alcohol, as well.

You have not written about Restless Leg Syndrome (and periodic leg movement), but it appears there is an association between RLS and celiac:

http://www.rls.org/Document.Doc?id=1782

Leg movement at night is often undetected and the cause of much fatigue for sufferers.

I would be hopeful that adherence to an anti-inflammatory diet and getting plenty of exercise would return you to essentially complete health. Most of the people who have changed their diets have had major improvements.

I would expect that the Epstein-Barr infection/mono is the root of your problems and that will be harder to get past than just dietary inflammation, but persistence in your diet and feedback from healthcare people on your status via bloodwork info, should make you feel young again. It will be hard to find a sympathetic and knowledgeable medical person to work with, since most are poorly informed on nutrition and inflammation. Get some info on your vitamin D status and work on the basic diet. You should see substantial improvement in a couple of weeks. You may also be B12 deficient.

First, thank you so much for your response. I have gotten my vitamin levels checked -- D was very low (17) and I've been supplementing at 5,000 IUs a day for about two months now. I DO feel much better, but it still doesn't take much to throw me off. I have been tested for allergies and it seems that I'm allergic to wheat but VERY allergic to all forms of yeast. Does this mean I can't drink any alcohol, ever? I'm trying to figure out what I can and cannot do if I want to heal, which I do, very badly. It just seems like I've sacrificed so much already and I just want to be better. I don't know what to do! I'm trying as best I can to be "normal" and engage in normal young person activities but I seem to do harm every time I do so. I'm not destructive -- I don't like to drink a lot and the only drug I do is marijuana (occasionally). I know my gut is probably super messed up. I'm taking something called "GI Protect" by Xymogen to heal it so I can absorb nutrients from my food again some day (I hope) but for now I'm supplementing like crazy in order to make up for the lack of nutrient absorption. I bruise ridiculously easily. I seem to have low body temperature and low blood pressure at times. I started taking vitamin K but heard it was contraindicated for people with thyroid problems so I stopped. Plus, I have genetic varicose veins and I feel like it may be making them worse. I also have other challenges, such as a genetic anemia trait (Thalassemia minor, beta). I don't get to exercise much these days given time constraints. I am 5'5" and about 121 pounds so weight is not an issue. I currently supplement with lots of Vitamins D, C, B, a multivitamin with lots of other stuff, good quality omegas, inositol, and probiotics. I am GF, only goat dairy (mostly yogurt), and relatively low sugar.I was wondering if, given this information, you have any recommendations to diet or lifestyle changes I can make to improve my state of health or -- FINALLY -- kick mono (and other viruses) out of my body?

Penelope,You are stuck with some of the virus infections for life, but that may not be a big deal, if you can get your immune system to function more normally. The gut is a major part of the immune system, so getting the gut in shape is a big step toward being healthy.

I don't know how the dermatologist checked for wheat allergy, but you didn't indicate if you were specifically checked for celiac, which is different.

You need to get the components of the basic inflammatory diet clearly in your mind and follow it with every meal. How you feel is the result of what you just ate. You need to read labels and you need to have access to food composition info. With thalasemia, you are already aware of the failings of the medical industry, so you have to take the responsibility for your own health.

Your D is still probably low and may slowly improve. You need sun exposure, but do it wisely. Enjoy exposing as much surface area as you can and focus on the areas that haven't been damaged by sunburn in the past. You can probably also increase your dose a little (up to 10,000 IU per day is ok even for pregnant women.) until your serum levels show an optimal level.

Get rid of grains as you avoid starch and shift to a low carb diet. That solves many problems and starts to train your gut flora.

You probably need a specific B12 supplement, so read up on it.

Your sensitivity to yeast is potentially very important. If you have chronic yeast infections, e.g. from antibiotic use, you would feel very bad. I don't know enough about thalassemia-associated problems to know what else you are likely to suffer from. I will have to take a peek at the med lit.

Typical multivitamin supplements don't usually change much and can't be relied upon for fixing deficiencies.

You say that you take omega-3s, but how much? The 3/6 ratio is what is important. If I were you, I would add two more fish oil (DHA/EPA) capsules to my daily amount and continue for two weeks, check my symptoms for improvement and continue until I saw an improvement. In the absence of any omega-6 use as vegetable oil, I would expect you to have to take up to 12 capsules per day to resolve your high level of chronic inflammation. Krill oil may give you better results with lower doses.

You may also have a lot of oxidation stress. You might get a handle on how high that stress level is by increasing your vitamin C to see what your tolerance is until you get some symptom such as diarrhea. I think that most people max out at 4-6 grams per day, but if you are using up a lot, your limit may be higher. Also look into taurine to help with cysteine needed for glutathione production for oxidation stress.

Each of these supplements addresses a deficiency that leads to inflammation and to some extent, the inflammation can be reduced with big doses of each. Once inflammation starts to get under control, then all of the supplements can be reduced.

It is difficult to establish a healthy gut flora, because it has not been adequately studied. One of the best approaches, based on the successes that people have had with fermenting bacteria, may be making your own yogurt from good, live commercial yogurt.

The potential complicating problems that you may have are celiac and maybe Helicobacter (stomach ulcer bacterium.) Alcohol consumption sometimes controls the Helicobacter. I am not impressed with the diagnostics for either of these and consider them uniformly underdiagnosed. All of these and the EBV lead to autoimmune diseases and allergies.All of these can be controlled by the basic anti-inflammatory diet found through the link at the top of the main page of this blog.

My sense is that you can always move toward health and youth by diet and exercise, and most genetic disadvantages can be overcome if chronic inflammation is avoided. I will check to see if thalassemias also have a predisposition toward inflammatory degenerative diseases.

Nick,Sorry that it took so long for my reply -- I have been getting two daughters back to college.

The response to reducing grains in terms of subsequent sensitivity is still perplexing. The starch and sugar sensitivity may reflect a reduction in insulin producing cells. I have the same sensitivity and I fear that it may be the early impact of prior dietary abuses that have led toward type II diabetes. I think that pancreatic B cells can recover, so maybe the sensitivity decreases over time.

The reference that you noted on celiac and restless leg syndrome is very interesting. I get quickly overwhelmed with neurobiology, so my take on all of the neurological ramifications of disease is that these are just symptoms that go away if the underlying cell biology is rectified, i.e. if I fix the part that I partially understand, then the part that I don't understand will fix itself.

Wow, contacting you has really been a blessing. I’m saving all of this info because it’s just so much valuable stuff to absorb! I understand that you are probably rather busy; you don’t have to keep responding. Any info you can offer helps immensely, of course. I feel really hopeful that I can get back to a state of wellness. I have been working hard at this for years… I’ve been misled by professionals (was told to be vegan, that was disastrous) and taken many wrong turns trying to figure out what was wrong, but I feel closer than ever these days.

I am currently taking a B12 sublingual tablet about once a week (from Xymogen, I get all my stuff from there even though it’s expensive because I really need these things to work). I used to take it more often but figured it wasn’t doing much. My omegas contain 360 mg of EPA and 240 mg of DHA, and I take them 2 – 3 times a day. I will look into Krill oil, I know Dr. Mercola sells it. I do take lots of Vitamin C… over 4000 mg a day I believe.

I took an ImmunoLab allergy test two years ago, not with a dermatologist but with a holistic MD. It showed allergies to wheat, eggs, and other things but yeast was by far the most reactive. I never get yeast infections – I’ve only had one in my life. But I suspected candida overgrowth in my gut for a while. I ate horribly years ago, was on birth control, was much heavier and was on several antibiotics (got Mono after this).

I was wondering what some of the tests are that check for a leaky gut and Helicobacter? I am seeing a gastroenterologist tomorrow.

I have no problem following the anti-inflammation diet, but I don’t know how or when or which type of carbs I can eat. I enjoy brown rice, beans, starchy veggies, etc. But I never know if it’s OK to eat them. They seem like “healthy” foods but I understand they turn to sugar. I did an extremely low-carb, no-fruit, no-sugar diet for two months (April, May and a little of June) and I couldn’t go to the bathroom normally at all the entire time. I felt terrible.

Now I usually eat protein & veggies. But for instance, today I had rice with raisins and carrots and a turkey burger, and for a snack later on I had a rice flour muffin and some chocolate. (Today I went a bit overboard.) I do love my sugar but I’m willing to give it up if I just know how much is OK. I know that zero carbs, zero sugar is no good because, as I said, I've tried it. I’ve kept a food journal for 146 days now… haha. I think many of my symptoms are delayed, hence it’s hard to say what causes them.

I found a really, really interesting paper about gut dysbiosis, chronic inflammation, bacteria biofilms and the recovery using probiotics, lactoferrin and proteolytic enzymes.http://www.scribd.com/doc/18583142/Gut-Recovery-Program-A-New-Approach-To-Treating-Chronic-Gastrointestinal-Infections

One of the best papers I stumbled upon in a long time (excluding yours, of course :-).

Cristian,You are right, that article is brilliant. It is embarrassing that I have written articles on the efficacy of lactoferrin in altering gut flora and on the ability of spices to alter quorum sensing in biofilms. I have been interested in the impact of iron in stomach acid production and in anemia associated with celiac, and the use of vinegar and EDTA in the treatment of a wide spectrum of disease. Phytic acid is a potent chelator and is the active component of dietatry fiber. I even studied acidic polysaccharides involved in biofilms and amyloid plaques, but I never put it all together in a very simple synthesis.

Biofilms disrupt gut physiology and impact all disease. Attacking biofilms cures. Biofilms can be attacked by destabilizing acidic polysaccharide/divalent cation interactions with acetic acid, chelators or small competing oligosaccharides, such as glucosamine or heparin.

Heparin released with histamine by mast cells may be a protection against biofilm formation!

This is an amazing synthesis of dozens of independent observations.

By the way, I think that the omega-3 paper that you referenced is fishy. It looks like they ignored the omega-6 vegetable oils in the diets. With high omega-6, the fish oil supplements used would not be expected to show effects. They should have tested a dosage effect. If they titrated the existing omega-6s, they would have seen results at higher omega-3 levels and revealed their experimental flaw.

Lucy,In my simple perspective, I see all allergies as derived from more fundamental sources of inflammation, such as diet. The chronic inflammation causes aberrant presentation of foreign and self proteins as antigens. The result is various allergies and autoimmune diseases. I also suspect that gut biofilms perpetuate the allergies and autoimmunity.

The major triggers for converting chronic inflammation into allergies and autoimmunity are Helicobacter infection of the stomach, celiac in the intestines and EBV/mono. I think that all of these are accompanied by intestinal biofilms over time.

If you respond to dietary gluten, then eliminating grains and switching to a low carb diet seems the obvious solution. I think that Helicobacter infections and celiac are grossly underdiagnosed. I would be very surprised if all food allergies were not based on pre-existing celiac (or Helicobacter.) Thyroiditis automatically follows celiac. Helicobacter automatically produces food allergies.

I have no problems with saturated fats/oils. The problem comes with omega-6 fatty acids in common vegetable oils (except olive oil). Flax/hemp oil is a problem, because it gets modified during processing. Flax seed, freshly ground, is good because it probably also acts as fiber. The flax seed won't help much as an omega-3, because it is short chained and is converted to the desirable long chain fatty acids (DHA, EPA) at low efficiency.

I like butter and eggs, and have no problem with them. Once you get your allergies under control, you can probably add them back.

May I suggest you take a look at the Enterolab website? www.enterolab.com

I used their genetic and fecal tests to determine that my son and I were better off without gluten in our diets.

We had positive results for anti-gliadin (gluten) IgA antibodies, anti-tissue transglutaminase IgA, and my son tested positive for fat malabsorption. We also both have two copies genes that predispose to either gluten sensitivity or celiac - not surprising for my son as there is at least one of my husband's relatives with diagnosed severe celiac disease). My two copies are for GS, and my son has one of these and one for CD.

Additionally, Entrolabs tests can be conducted even if you've been off gluten for a while, even as much as 6-12 months, though of course less tiem is better. I'd had a very low intake of wheat for several years as part of a LC read food diet (a few bites here and there and very few processed foods that contained wheat ingredients), but hadn't really attempted GF until after my positive test results. I doubt I would have tested positive had I been tested through the usual blood tests or biopsy via my doctor. A food allergy panel was done in 2006 (by a doctor that was fishing for reasons to not raise my dose of thyroid hormone) that was entirely negative.

Except in NYS, you generally don't need a doctor's order to do Enterolabs tests. However, that might also mean you might not be able to get the tests covered by your insurance company. I felt it was worth the out-of-pocket expense, but YMMV.

Pillocks like "Sharon" and "saliva drug test" have one redeeming feature. They bring me back to your excellent historical articles with their comments sections. This particular post has been, and continues to be very inspirational to me.

I have had a high ANA level for at least the past 10 months ... maybe longer (320:1 and 640:1). I have seen multiple docs, including a rheumatologist, but the only Dx made was "undifferentiated connective tissue disease" ... with no recommendations about what to do about the numbers or about my symptoms of extreme fatigue and depletion. Is it possible that my high ANA is related to inflammation which is related to gluten sensitivity? Mainstream docs are now recommending antidepressant medication ... I wasn't depressed BEFORE all this started happening to my body and I sure don't think antidepressants are a viable way of addressing it!

Anonymous,Your symptoms, as I have discussed in several other posts, are consistent with the initial stages of autoimmunity based on a combination of diet-based chronic inflammation and disruption of gut flora/GALT interactions. In other words, all of your problems are based on diet (and perhaps, as you point out, gluten intolerance).

Mild depression, in contrast to severe clinical depression, does not respond to antidepressants and is a symptom of chronic inflammation. The cytokines in the serum are the same in both cases, inflammatory.

This article and others that deal with more details about an anti-inflammatory diet that should address all of your health problems. You might also look into low dose Naltrexone, since it also addresses all of your health symptoms.

I have been grain free 20 of my 70 years. My health is getting better by the year. I do best on a high fat diet (coconut, animal)with maybe 5 to 10% carbs (no starches), b12 shot once a month, 5000 IU D, vitamins, minerals, fish oil, etc. The high fat mostly animal diet was added in the last 3 years & has moved me to a new level of health. The other things were started 20 years ago.

At 15 years old I had a ruptured appendix, which was unattended for 2 days. This was a very near death experience, which changed by immune system. I had several autoimmune issues for the next 35 years. I must be very careful with the food I eat. One bad meal & I pay for days or weeks.

BR,I think that what changed your immune system was the antibiotics given after the ruptured appendix. The loss of your appendix also was the loss of a source of stored gut flora.

Your gut flora have never recovered and is still fragile, hence your dietary intolerances. I think that you can return to a more robust digestive system simply by gradually increasing the diversity of your gut flora by eating diverse foods and by bringing in new bacteria.

After 10 doctors, 2 rheumatologists and 2 Neurologist, misdiagnosed for over 15 years, felt poisoned and treated like a hypochondriac, I was finally tested for gluten levels. Normal results 0-10 mine 72.9! I was 5'7 1/2' I weighed over 200lbs. I was put in touch with a woman named Sue Hassette 6 days after my diagnosis, who wrote a book called Living with Celiac disease and was a God send to me. I have been gluten free two years this April. The first symptom that was gone was the horrific migraines! I lost over 50lbs painlessly, got rid of my cane, and the loss of cellulite was a bonus....lol. Though I am no longer swearing as I shop and read labels, I do admit to groping fresh Itallion bread from time to time on my way out of the bakery section. My biggest issue lately is that I find myself craving raw potatoes.

Hello Dr,I am gluten intolerant, probably celiac, diagnosed over 25 years ago ( we by-passed the biopsy and just went to lifestyle diet change) I am mostly grain free also, find it to be the best course for the most part. My diet has no added sugars for the most part, low on dairy, no soy and a significant amount of raw and lightly cooked veggies. I have begun daily fermented food portions, but it's not yet showing a change. I am prone to inflammation anytime my gut reacts to a food in an unfavorable manner.I began taking split doses of niacin recently, 50 mg twice daily and find that any inflammation in my skeletal system, joints , etc seems to abate. I am trying to research inflammatory response and niacin. When i take the split dosage, i minimize the "flush" response ( so i can leave the house without looking like a lobster) But i still get the relief from body inflammation. It is wonderful, but other than my anecdotal responses, i have not been able to find any strong science for it. Do you have any insight?~L

Wow, what a blog! I mean, you just have so much guts to go ahead and tell it like it is. Youre what blogging needs, an open minded superhero who isnt afraid to tell it like it is. This is definitely something people need to be up on. Good luck in the future, manhoney benefits

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About Me

I grew up in San Diego and did my PhD in Molecular, Cellular and Developmental Biology (U. Colo. Boulder). I subsequently held postdoctoral research positions at the Swedish Forest Products Research Laboratories, Stockholm, U. Missouri -Colombia and Kansas State U. I was an assistant professor in the Cell and Developmental Biology Department at Harvard University, and an associate professor and Director of the Genetic Engineering Program at Cedar Crest College in Allentown, PA. I joined the faculty at the College of Idaho in 1991 and in 1997-98 I spent a six-month sabbatical at the National University of Singapore. Most recently I have focused on the role of heparin in inflammation and disease.